Social Anxiety Treatment

How to Overcome Social Anxiety?

Living with Social Anxiety Disorder, or SAD, can be one of the major challenges in a person’s life. This is true whether an individual is officially diagnosed, or simply experiences social anxiety symptoms on a regular basis which significantly impact her quality of life. The first step to overcome social anxiety is to seek help, and most people never do so. In fact, more than 80% of affected people never receive treatment for social anxiety during their lives (Grant et al., 2005). A study performed by Coles, Turk, Jindra and Heimberg (2004) found that only 15% of socially anxious people who initially contacted an anxiety clinic proceeded to receive therapy for social anxiety.

About 80% of people with social anxiety disorder never receive professional help, despite effective treatments being available. Paradoxically, this is often due to the fear of being judged or negatively evaluated by the therapist.
About 80% of people with social anxiety never receive professional help.

Among the reasons why people refrain from seeking or accepting professional help seem to be the potential economic burden, a lack of professionals familiar with the dynamics of social anxiety disorder or having to travel long distances to see them, and paradoxically the fear of being judged and negatively evaluated by the therapist (Mechanic, 2007; Olfson et al., 2000). Those who do seek help usually find one response: “Cognitive behavioral therapy  for social anxiety disorder (CBT) is the only effective treatment”. But is that really the case or are there alternative approaches that have been proven effective in scientific studies and can lead to a cure for social anxiety?

The Silver Bullet for Social Anxiety: Does it Exist?

Social anxiety disorder accounts for the third most common mental health condition in the world today. However, finding valid, trustworthy and upright information concerning the disorder can be quite challenging. When it comes to overcoming social anxiety, many self-proclaimed gurus declare they have found the secret formula:

  • “Overcome social anxiety completely
  • “Beat social anxiety within days
  • “Crush your insecurity and turn into a social beast
  • “Cure your social anxiety in one session

Promises like these are tempting, especially for people who are suffering and are looking for a way to get better as fast as possible. Ethically, claims of this type should be questioned. Even if there were an easy and magic solution, it would still be problematic promising a suffering individual you can and will provide it.

Social anxiety was officially recognized as a disorder in 1980 by the American Psychiatric Association. Ever since, researchers all over the world have been trying to better understand the phenomenon and come up with effective treatments. For many years, cognitive behavioral therapy (CBT) was considered the go-to treatment for social anxiety and for many mental health professionals it still is.

But CBT is not the only valid treatment option. The last decade was an exciting time in the area of social anxiety research. The recent mindfulness wave has brought along changes in existing treatment plans and has created completely new approaches.

None of the scientifically studied therapies can be regarded a silver bullet – they still require effort and time, and they do not turn a person’s personality and life upside down. But many studies have shown that they often lead to significant reductions in social anxiety symptoms and subjective suffering and that they can lead to remission of the disorder in many cases. So, what are the official treatments for social anxiety disorder?

Psychotherapy for Social Anxiety Disorder – The State of The Science

There has been extensive research on the effectiveness of different treatments for social anxiety disorder. In recent years, the field has come up with important insights which have led to significant alterations in existing therapies as well as created completely new approaches. While treatment plans for social anxiety that were developed in the 90’s encouraged to challenge and actively change intrusive thoughts, newer approaches advocate acceptance of these as well as of uncomfortable feelings.

Although much remains to be discovered, there have been some exciting findings which make psychotherapy for social anxiety increasingly effective. Given that it is not easy to find pertinent and holistic information concerning the different treatments, we have put together an eBook which summarizes the 17 distinct approaches that have been scientifically studied. We have decided to make it available to the public for free, since we want to encourage affected people to be well informed about different ways to overcome social anxiety.

When talking about treatment for social anxiety, cognitive behavior therapy has to be included in the conversation. As mentioned before, it is widely considered the standard treatment for social anxiety disorder and is oftentimes able to cure or at least significantly reduce it. It is based on the premise that dysfunctional beliefs and behavior patterns cause and maintain social anxiety symptoms.

Cognitive Behavioral Therapy for Social Anxiety Disorder

Cognitive behavior therapy for social anxiety is based on the cognitive model of the disorder. Several models have been proposed. However, most of them are simply slight variations of the most commonly accepted model by Clark and Wells (1995).

The cognitive model of social anxiety disorder by Clark and Wells emphasizes past negative experiences which lead to an interplay between negative thoughts, self-consciousness, anxiety symptoms and safety behavior. Cognitive behavioral therapy for social anxiety aims to breaks this vicious cycle.
The cognitive model of social anxiety disorder by Clark and Wells is among the most commonly accepted explanations for the development and maintenance of social anxiety disorder. Cognitive behavioral therapy aims to alter negative beliefs and assumptions, and targets maladaptive attentional processes and behavior patterns.

The cognitive model of social anxiety disorder emphasizes the importance of past negative social experiences for the development and maintenance of the condition. A person might have been laughed at for making a mistake when reading out loud in class during adolescence. Whenever a similar social situation arises, memories and related negative beliefs as well as assumptions about herself and others are triggered. Possible beliefs in this particular case could be:

  • “I will make a fool of myself when reading the outline of the meeting to my colleagues.”
  • They will notice how nervous I am and make fun of me.”
  • No one will respect me anymore and my boss will think I am incompetent.”

These thoughts are believed to fuel self-consciousness, anxiety symptoms and safety behavior. In turn, these components are believed to feed of each other, increasing the person’s social anxiety even further. In the example mentioned above, the person may practice excessively reading the outline out loud beforehand and wearing light clothes in an attempt to control her anxiety symptoms, which likely produces a paradoxical effect, further increasing her anxiety. She might imagine the worst case scenarios before the event and see herself as insecure while presenting the outline, which yet again worsens her anxiety symptoms. These, in turn, will increase her self-consciousness even further, trapping her in a vicious cycle of social anxiety.

Cognitive behavioral therapy for social anxiety disorder reduces anxiety symptoms by changing negative thoughts, training the person’s ability to deliberately direct attention away from fear-provoking stimuli, and by seeking exposure to the feared social situations.

Cognitive behavior therapy attempts to alter negative thoughts related to the feared situations, train the person’s ability to deliberately direct her attention away from her bodily sensations and how others may see her, as well as encourage exposure to the feared situations. This combination of interventions mostly leads to a decrease in social anxiety symptoms as well as improves the person’s ability to face and deal with the feared situations.

To learn more about the distinct features of cognitive behavioral therapy and how it can help you to overcome social anxiety, please feel free to visit our section on CBT.

Psychodynamic Psychotherapy for Social Anxiety Disorder

Another well-studied, but often underrated psychotherapy for social anxiety is psychodynamic treatment. Psychodynamic therapies are interested in the underlying, often unconscious emotional conflicts of social anxiety, which have been described as a “conflict between craving praise and dreading not receiving it; wishing for adulation amidst the worry that it is undeserved” (Hoffman, 2018, p. 7).

An insecure attachment style has been found to possibly predispose an individual to develop social anxiety disorder. Psychodynamic treatment for social anxiety tries to identify patterns in a person's way to relate to others. These are usually formed in early childhood and depend on a person's attachment style.
An insecure attachment style has been found to possibly predispose an individual to develop social anxiety disorder. Psychodynamic treatment for social anxiety tries to identify patterns in a person’s way to relate to others. These are usually formed in early childhood and depend on a person’s attachment style.

According to various psychodynamic research interviews (McEvoy, O’Connor, & McCarthy, 2016), one of the main developmental struggles for people suffering from SAD seems to be reaching an authentic self, an own identity which has its own opinions, aware of its needs and wishes and is able to give voice to them in interaction with others.

Most people with social anxiety wish nothing more than being accepted, noticed and admired by others. When this desire is very intense and the person is convinced to not be worthy of love and approval, an inner conflict may arise which can lead to intense emotional reactions in situations of possible social evaluation. However, this conflict and the underlying wishes and convictions may be unconscious. Psychodynamic psychotherapy for social anxiety disorder aims to gain clarity over these aspects and provide new ways of positioning the self in relation to others.

Psychodynamic psychotherapy for social anxiety disorder argues that most people with social anxiety crave acceptance and admiration, while believing at the same time that they don't deserve it. This conflict leads to social anxiety symptoms.
It has been argued that many people with social anxiety crave acceptance and attention while at the same time believing that they do not deserve it. This conflict is believed to lead to social avoidance and social anxiety symptoms.

Among the main differences in comparison to other approaches is the focus on early childhood experiences, especially the relationship to parents and early childhood caregivers of the individual, and how these affect the patient’s experiences in the present (Leichsenring et al., 2013).

In order to learn more about psychodynamic treatment for social anxiety and how it can help you overcome your struggle with insecurity, please feel free to head over to our respective section.

Mindfulness & Meditation for Social Anxiety Disorder

The mindfulness wave of the last decade has led to significant adjustments in the treatment for social anxiety as well as created completely new approaches. One of its main ideas relates to the tendency to fight uncomfortable thoughts, feelings and sensations. Socially anxious people usually try to combat their anxiety or physical symptoms, which tends to intensify them. Mindfulness teaches to observe and notice what is happening without the intention to alter the experience in any way.

Mindfulness has been described as “paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally”, by Jon-Kabat-Zinn (1994) from the University of Massachusetts Medical School. It can be seen as a practice which has the potential to decrease our natural tendency to fight any unpleasant experiences. For this reason, it represents an intervention with great potential for socially anxious people.

Instead of challenging uncomfortable feelings and counterproductive thoughts, mindfulness-based approaches for social anxiety teach psychological acceptance of these phenomena. Like this, it bypasses the ironic thoughts process – a psychological phenomenon which paradoxically intensifies a thought or sensation when the person actively tries to suppress it.

But this is not the only reason why mindfulness and meditation are usually great interventions for people with social anxiety disorder. Regular meditation practice has been shown to affect brain activity, as the prefrontal cortex becomes thicker and gains more influence over the amygdala, also referred to as the fear center of the brain. In stressful situations, the brain is then more likely to remain calm and not overreact when there is no real objective threat. In the case of social anxiety disorder, the threat is often imagined or drastically amplified by the affected person. Therefore, training the brain through meditation to maintain control in stressful situations is a great practice for socially anxious individuals.

To learn more about mindfulness as well as other types of meditation, and how you can use them as an antidote for social anxiety, feel free to visit our guided meditations section.

Compassion-Based Treatment for Social Anxiety Disorder

Another new treatment approach for social anxiety that has been emerging over the last two decades is based on compassion. The term refers to a “sympathetic consciousness of others’ distress together with a desire to alleviate it” (Merriam-Webster, 2020).

Compassion-focused therapy is based on the idea that humans evolved having three different basic motivational-emotional systems (Gilbert, 2014). While the threat and competition systems tend to activate and arouse us, the affiliative system has soothing qualities and puts us in a prosocial state. When this latter system is activated, our brain works and organizes its activity in a way which promotes mental health and significantly lowers anxiety.

Compassion-focused therapy aims to train people’s ability to cultivate affiliative emotions related to others and towards themselves. In fact, reacting with self-kindness and self-compassion when faced with personal flaws or failures has been shown to have an anxiety-buffering effect (Werner et al., 2012). However, socially anxious people tend to miss out on this mental health benefit due to their low levels of self-compassion and their marked habit to criticize themselves.

In fact, people with social anxiety disorder represent a group with particularly high levels of self-criticism (Cox, Fleet, & Stein, 2004). Another therapeutic approach which is based on the way we relate to ourselves is mindful self-compassion (Neff, 2003). As the name suggests, it focuses on becoming aware of our own suffering and reacting with compassion and kindness when we have to endure difficult moments.

Socially anxious people have a strong tendency to be harsh on themselves when it comes to their flaws, particularly their own social anxiety. Mindful self-compassion advocates the idea that criticizing ourselves when we are down only amplifies the problem and our suffering. Instead of putting ourselves down, it encourages people to react with compassion for themselves, as they would with a friend who was going through a difficult moment.

Harwood and Kocovski (2017) examined what happened when people high in social anxiety measures engaged in a self-compassion inducing exercise before a speech task. Results showed clear benefits for these individuals and confirmed once again the previously mentioned anxiety-buffering effect of self-compassion.

To learn more about compassion-based treatments for social anxiety disorder, feel free to visit the following section.

Metacognitive Therapy for Social Anxiety Disorder

While the previously mentioned model proposed by cognitive psychology highlights the importance of maladaptive social beliefs about the self and others, the metacognitive model emphasizes that certain beliefs about thinking itself play a crucial role in SAD. That is, it does not focus on the ideas an individual has about herself or others in a given social situation, but rather on her beliefs and habits related to her cognitions. If this still seems confusing, stick with us for another moment.

Socially-anxious people tend to assume that certain thoughts are dangerous and that controlling them will therefore be beneficial. Their attempts to do so, however, often fail and thus confirm their beliefs about the dangerousness of certain thoughts, further strengthening the monitoring of their mental processes in social situations. This phenomenon is referred to as cognitive-attentional syndrome (Wells, 2009).

Our metacognitions lead to certain thinking styles (Wells, 2009). In the case of social anxiety disorder, a person may believe it is helpful to worry about what could go wrong in an upcoming social event in order to be prepared. In the same way, she might think that ruminating about a past event can help her avoid certain behavior or physical symptoms in the future. These beliefs about thinking tend to increase the anxiety instead of reducing it.

People with social anxiety are usually highly alert when with others and tend to focus on any signals of social threat or disapproval. Many affected people believe that being hypervigilant to such signals can help them detect potential danger and avoid it. What this really does in most cases is putting the individual in a state of constant alert which raises anxiety levels.

Metacognitive therapy for social anxiety targets this phenomenon and its underlying beliefs about mental processes (Nordahl & Wells, 2017). Our blog post on the topic illustrates how metacognitive therapy approaches treatment for social anxiety.